title: Pylorus resection in partial pancreaticoduodenectomy: impact on delayed gastric emptying.
abstract: BACKGROUND
  Partial pancreaticoduodenectomy (PD) is complicated by postoperative delayed gastric emptying (DGE) in up to 45% of patients. The aim of this study was to evaluate the impact of pylorus resection on DGE following PD.
  
  
  METHODS
  Forty PD patients underwent pylorus resection with complete stomach preservation (prPD). They were compared with a pair-matched group of PD patients with pylorus preservation (ppPD) in a 1:1 ratio (age, sex, histopathology). The objectives were operative parameters, DGE incidence, morbidity, and length of hospital stay.
  
  
  RESULTS
  DGE incidence was significantly lower after prPD (15.0% vs 42.5%; P = .0066). Operative parameters and surgical morbidity (other than DGE) were not different (27.5% prPD vs 30.0% ppPD). There was a trend toward a shorter hospital stay in the prPD group.
  
  
  CONCLUSIONS
  Resection of the pylorus with stomach preservation significantly reduces the frequency of DGE after PD without showing any disadvantage when compared with standard ppPD. This finding could be of high relevance for the clinical practice in routine PD and should consequently be investigated in a large randomized multicenter trial to create further evidence.
authors.affiliation: Department of Surgery, University of Heidelberg, Germany. Thilo_Hackert@med.uni-heidelberg.de
authors.forename: Thilo
authors.initials: T
authors.lastname: Hackert
authors.forename: Ulf
authors.initials: U
authors.lastname: Hinz
authors.forename: Werner
authors.initials: W
authors.lastname: Hartwig
authors.forename: Oliver
authors.initials: O
authors.lastname: Strobel
authors.forename: Stefan
authors.initials: S
authors.lastname: Fritz
authors.forename: Lutz
authors.initials: L
authors.lastname: Schneider
authors.forename: Jens
authors.initials: J
authors.lastname: Werner
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D018589:Gastroparesis / Q000453:epidemiology / Q000503:physiopathology*; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016577:Pancreaticoduodenectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology*; D011446:Prospective Studies; D011708:Pylorus / Q000601:surgery*; D018709:Statistics, Nonparametric
keywords: Delayed gastric emptying; Partial pancreaticoduodenectomy; Pylorus resection